Wednesday, October 5, 2011

It’s not a statistic that's going to make you feel proud to be an American. Nonetheless, America is leading the world in mental illness. Yes, indeed, we’re number 1.

We also rate high on the substance abuse scale, though we are not first.

Writing in The Atlantic, Alice Walton frames the question: “That mental health disorders are pervasive in the United States is no secret. Americans suffer from all sorts of psychological issues, and the evidence indicates that they're not going anywhere despite (or because of?) an increasing number of treatment options. There are the mood disorders like depression, bipolar disorder, and the less severe dysthymia (low grade depression); anxiety disorders like generalized anxiety disorder, social phobia, agoraphobia, and obsessive-compulsive disorder (OCD); substance abuse; and impulse control disorder (like attention deficit/hyperactivity disorder). Research shows that while we're seeking treatment more, rates have not dropped much, if at all, in recent years. For depression alone, about one in 10 people in America has suffered from it in the last year. Twice that number will be affected over the course of a lifetime.”

While Americans are getting more treatment for mental illness, the treatments do not seem to be having a measurable effect on the incidence of mental illness.

At the least, it appears that mental health treatments are not very effective. It also appears that all of the glowing reports about how far we have advanced in treating mental illness have been larded over with more than a little hype.

Walton even hints at the intriguing possibility that the availability of different options might be causing the increased demand for service.

We should acknowledge that for quite some time now ours has become a therapy culture. In a strange way we are providing people with a continuing and ongoing experience of therapy in their everyday lives. If that doesn't make you crazy, nothing will.

Take an easy example. In many American schools teachers are less concerned with whether children learn anything than with whether or not they have high self-esteem.

They inflate grades, refuse to find fault, and pretend that all children are equally capable.

The self-esteemist movement has transformed the classroom into a group therapy session where no one is allowed to feel badly for having failed.

Many American teachers have become merchants of illusion. They have produced a younger generation that scores low on competitive tests while asserting that it is the best.

When you ignore the evidence of your mediocrity and continue to think that you are the best, you are being set up for a harsh awakening.

One of these days, reality is going to bite. Since you were never told that you had failed, you do not know how to deal with disappointment and failure.

You will be more likely to give up and move back in with your parents or go out to rage against the machine. Both will contribute to America’s high incidence of mental illness.

And then there is the cult to sensitivity. We are all supposed to be sensitive to other people. We are supposed to be quick to take offense but slow to give offense.

This cult teaches people to feel anxious all the time lest they offend anyone or ruin their reputation with an errant remark.

These practices undermine social relationships, making each individual a potential threat, not a potential friend. None of this contributes to the nation’s collective mental health.

Corporations have jumped on this bandwagon, offering sensitivity training sessions. Forcing their employees to engage in these bastardized forms of group therapy, the companies undermine morale and self-respect by telling everyone to admit in public, for example, to the most embarrassing thing that has ever happened to them.

It should not be a secret, but washing your dirty linen in public does not contribute to your self-respect or your mental health.

Want some more bad news? It appears that America’s appetite for leisure and sloth is contributing mightily to our quota of mental illness. And this, without even considering the obesity epidemic that has been running rampant in our over-therapied nation.

Everyone should know by now that if physical exercise contributes to mental health—aerobic exercise works wonders for many kinds of depression—then laziness must be helping to keep us depressed.

Walton reports: “Ron Kessler, Ph.D., the Harvard researcher who headed much of the WHO’s mental health research, says that by and large people in less-developed countries are less depressed: After all, he says, when you’re literally trying to survive, who has time for depression? Americans, on the other hand, many of whom lead relatively comfortable lives, blow other nations away in the depression factor, leading some to suggest that depression is a ‘luxury disorder.’”

If Kessler is right, a culture that values leisure over work would be more likely to promote depression.

As I discussed yesterday, serious thinkers like Jeffrey Sachs are trying to make American culture less work-oriented and more pleasure-oriented.

By Kessler’s reasoning, their effort to undermine the Protestant work ethic is helping to keep us in first place for mental illness.

This recalls the oft-quoted words of Kessler’s Harvard colleague, Dr. Richard Mollica: “the best anti-depressant is a job.”

It makes perfectly good sense. A job gets you off the couch and into the real world. A job allows you to base your self-respect on real accomplishment. A job organizes your time, gives you responsibilities, and confers membership in a group.

But, if a job, along with an exercise regimen, cures many forms of depression why all of the psychiatric hoopla about SSRIs?

America does not have enough jobs on offer today. Young Americans are part of what is fast becoming a lost generation.

Part, but not all, of the problem is that America does not have jobs that young people, in particular, would accept or would be qualified for.

Brought up in a culture of empty self-esteem and creative fulfillment, young people often feel that they are too good for the jobs on offer.

Many of them would rather sit around playing video games than take jobs that they consider beneath them.

Others believe that a job should allow them to find themselves and to develop their creativity. Holding this attitude, they become incapable of holding down a real job. Thus, they do not gain the satisfaction of a job well done, or qualify for many of the good jobs that are out there. Sadly, this puts them on the road to mental illness.

If you wanted to create a culture that would produce the most more mental illness you could not do much better than our therapy culture.

Very good blog. And more than an element of truth, I think.Walton even hints at the intriguing possibility that the availability of different options might be causing the increased demand for service.~~everybody wants a happy pill rather than deal with anything. I literally had a psychiatrist say to me (over the top happily I might add) that she wanted her client to try this pill (he was on 3-4 others), because itwould make him feel wonderful!I have three sisters who have a history of illicit drug abuse...they liked how it made them feel, they felt great, invincible.Now 20 + years down the road, they get them legally. They discuss their meds and how this one weighs against that. They take them til they're happy. Nothing bothers them. Nothing. And when it does they adjust their meds. One will just take another pill if she starts feeling anxious, until she is literally skipping down the street. Picture 5'3" 200 pounds and 44 yrs old doing this...but she's happy. In short, we have the same behaviors as 20 years ago, but their dealers are licensed to prescribe. I will accept that there are those that are truly mentally ill. But I think many just don't want to, or can't deal with the ups and downs of life. They think, and you allude to, life is always up.And if it's not,it needs to be. I look back at my Father who, though he was there when needed, would often say, 'You made your bed...' He left it in my lap, and expected me to either fix it (and fix it appropriately), or deal with the consequences. Annoying at the time, but I think beneficial in the long run. I learned I could screw up, and I had to learn to fix or deal.Well anyway that's my rant on the subject.

This is an outstanding post. Thank you! I do believe there are a few modalities of therapy that can give us some new tools for bringing us back to reality and learning to deal with this most imperfect world rather than escaping from it through fantasy and drugs, but they are few and far between and can be extremely painful because they force us back on ourselves!

I discovered your blog a few months ago and it quickly became daily de rigeur reading (with apologies for the lame alliteration).

Allow me to offer another example. My neighbor is an elementary school principal. An accomplished woman, respected in her field, well-liked, etc. I've known for years that she conferred with a therapist, but only recently learned that she sees this person DAILY. Think about this - this therapist created another dependency so that this woman alledgedly cannot function without seeing him/her every day. Really? REALLY? And of course, the County medical pays for it all but that is for another discussion.

Thank you, Webutante. I hope everyone takes the time to read your own excellent blog.

And thanks for the kind words, Frank. I am only surprised to find that any insurance company is still paying for 5 times a week therapy.

Many years ago the federal government insurance in Washington, DC decided that it would pay for five times a week therapy. This caused large numbers of psychoanalysts to relocate to Washington. Eventually, the insurance company caught on and put an end to the practice.